The U.S. Centers for Disease Control and Prevention (CDC) has released a guideline for the diagnosis, prognosis, and treatment of mild traumatic brain injury (mTBI) in children -- including recommendations regarding head imaging -- in a September 4 publication in JAMA Pediatrics.
The CDC established a federal advisory committee, the Pediatric Mild Traumatic Brain Injury Guideline Workgroup, to conduct a systematic review of relevant evidence and expert opinion on pediatric mTBI that was published between January 1990 and July 2015.
Among 19 sets of recommendations detailed in the final guideline, one of the sections specifically addresses the role of medical imaging in diagnosing the condition. The guideline recommends against the routine use of head CT, MRI, SPECT, or x-ray for the evaluation of suspected or diagnosed mTBI in children.
Though several studies examined in the review demonstrated the potential of CT to identify intracranial injury in 5.2% to 7.5% of pediatric mTBI cases, all of the findings were associated with low confidence. The committee additionally cited a number of potential disadvantages of neuroimaging, including increased costs, need for sedation, and radiation exposure.
Instead, the committee favored the use of validated clinical decision rules to diagnose pediatric mTBI. An initial assessment based on decision rules could then drive clinicians to request a head CT exam or further workup for patients with a high risk of intracranial injury.
![Axial images from unenhanced calcium score cardiac CT (left) and curved planar reformation images from CT angiography (right) show that higher long-term exposure to air pollution is associated with greater coronary artery calcium and more obstructive coronary artery disease (CAD). Top row: Images in a 68-year-old male patient with higher 10-year mean ambient air pollution exposure (7.9 μg/m3 for particulate matter measuring ≤2.5 μm in diameter [PM2.5] and 17.4 parts per billion [ppb] for NO2) with extensive CAD (coronary artery calcium score [CACS] >1,000 and obstructive CAD [≥70% diameter stenosis]). Bottom row: Images in a 57-year-old female patient with lower 10-year mean ambient air pollution exposure (6.3 μg/m3 for PM2.5 and 4.6 ppb for NO2) with no CAD (CACS = 0 and no obstructive stenosis).](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/06/hanneman.r6SMLzkezo.png?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
